Citation Nr: 9828374
Decision Date: 09/23/98 Archive Date: 10/01/98
DOCKET NO. 96-25 304 ) DATE
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On appeal from the Department of Veterans Affairs (VA)
Regional Office (RO) in Boston, Massachusetts
THE ISSUES
Entitlement to service connection for left ankle, left knee,
right hip, low back, and left wrist disabilities, claimed as
secondary to service-connected amputation of the right foot.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
L. J. Vecchiollo, Counsel
INTRODUCTION
The veteran served on active duty from November 1968 to
January 1970.
This matter comes to the Board of Veterans’ Appeals (Board)
on appeal from a December 1995 RO rating decision that denied
secondary service connection for left ankle, left knee, right
hip, low back, and left wrist disabilities, all claimed to be
due to a service-connected right foot amputation.
REMAND
The veteran served in the Army as an infantryman. While in
combat in Vietnam in August 1969, his right foot was severely
injured when he stepped on a land mine; extensive treatment
followed; and he was medically released from active duty in
January 1970. In March 1970, shortly after service, the
right foot was amputated due to the service injury, and a
foot prosthesis was provided. Service connection is in
effect for the right foot amputation (rated 40 percent, plus
special monthly compensation based on loss of the foot) and
for post-traumatic stress disorder (rated 50 percent).
In December 1994, the veteran filed claims for secondary
service connection (see 38 C.F.R. § 3.310 (1998); Allen v.
Brown, 7 Vet.App. 439 (1995)) for left ankle, left knee,
right hip, and low back disorders, all claimed to be due to
the service-connected right foot amputation. He essentially
contends that a gait disturbance from the right foot
condition has placed undue stress on other areas of the body,
resulting in the claimed conditions. In support of these
claims, the veteran submitted a December 1994 statement from
Richard D. Alexander, M.D. The doctor reported the veteran’s
symptoms of the left ankle, left knee, right hip, and low
back; and the doctor essentially opined that the symptoms
were related to “favoring” the left side due to the
service-connected right foot amputation. The veteran also
submitted a January 1995 statement from a chiropractor,
Jeremiah J. Kelley, D.C. This doctor noted left lower
extremity and back problems, and opined that the veteran
experienced lower extremity and spine dysfunction due to the
right foot amputation which had caused an altered gait and
structural imbalance. The Board finds that the veteran has
submitted evidence to show well-grounded (plausible) claims
for secondary service connection for left ankle, left knee,
right hip, and low back conditions; thus, there is a VA duty
to assist him in developing the claims. 38 U.S.C.A.
§ 5107(a) (West 1991); 38 C.F.R. §§ 3.103, 3.159 (1998);
Murphy v. Derwinski, 1 Vet.App. 78 (1990). To assist the
veteran with these claims, the RO provided VA examinations in
March 1995, but, as noted in the March 1997 decision by the
RO hearing officer, the VA examiners did not offer medical
opinions as to the matter of secondary service connection.
In the judgment of the Board, another VA examination, with an
opinion on the etiology of the claimed conditions, is
warranted. Moore v. Derwinski, 1 Vet.App. 401 (1991). Any
additional relevant treatment records concerning the claimed
disabilities should also be obtained. Murincsak v.
Derwinski, 2 Vet.App. 363 (1992).
In January 1995, the veteran also claimed secondary service
connection for residuals of a left wrist injury which he said
he sustained in a fall caused by his service-connected right
foot amputation. He subsequently explained that he fractured
the left wrist when he fell in 1978, and was then treated at
Salem Hospital in Massachusetts. The veteran submitted a
September 1996 statement from Christine Tasker, LPN (licensed
practical nurse) and a November 1996 statement from Christine
Nicholson, LPN, to the effect that each knew the veteran in
1978 when his right foot prosthesis broke, causing hip to
fall and break his left wrist. (From the handwriting, it
appears the same person signed both letters, and there may be
only one Christine.) The Board notes that the cause of the
reported fall involves more of a factual determination for VA
adjudicators, rather than a medical question of causality.
Harvey v. Brown, 6 Vet.App. 390 (1996). Regardless of
whether or not this claim for secondary service connection is
well grounded, the VA has an obligation to help the veteran
complete his application for benefits. 38 U.S.C.A. § 5103(a)
(West 1991); Robinette v. Brown, 8 Vet.App. 69 (1995). The
file contains no medical records from the reported treatment
for a left wrist fracture in 1978. Although it was
discussed, at the September 1996 RO hearing, that the veteran
should attempt to get such records, the Board believes that
another effort should be made to secure them, and the veteran
should be given another opportunity to submit any other
evidence to support this claim.
In view of the foregoing, the case is REMANDED for the
following action:
1. The RO should ask the veteran to
identify (names, addresses, dates) all VA
and non-VA medical providers who have
ever treated or examined him for
disorders of the left ankle, left knee,
right hip, low back, and left wrist. The
RO should then contact the sources and
obtain the related medical records, which
are not already on file, following the
procedures of 38 C.F.R. § 3.159. This
includes securing all emergency room and
hospital records (including patient
history) from Salem Hospital concerning
the left wrist fracture which reportedly
occurred in or about 1978.
2. The RO should ask the veteran to
identify Christine Tasker and Christine
Nicholson, who signed the 1996 letters
concerning the left wrist fracture; he
should indicate whether or not these are
the same person. The RO should also give
him an opportunity to submit any other
evidence (eyewitness statements,
acccident reports, etc.) concerning the
reported 1978 fall and left wrist
fracture.
3. Thereafter, the RO should have the
veteran undergo a VA orthopedic
examination to ascertain the existence
and etiology of disabilities of the left
ankle, left knee, right hip, and low
back. The claims folder should be
provided to and reviewed by the examiner.
Based on examination findings, historical
records, and medical principles, the
doctor should provide a medical opinion,
with full rationale, as to whether
symtoms from the service-connected right
foot amputation (including any gait
disturbance) caused or permanently
worsened (and if so aggravated, to what
degree) disabilities of the left ankle,
left knee, right hip, and low back.
Thereafter, the RO should review the claims. If the claims
are denied, the veteran and his representative should be
issued a supplemental statement of the case, and given an
opportunity to respond, before the case is returned to the
Board.
L. W. TOBIN
Member, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1997).
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